Derivation and validation of a mortality-risk index from a cohort of frail elderly patients hospitalised in medical wards via emergencies: the SAFES study.
To identify predictive factors for 2-year mortality in frail elderly patients after acute hospitalisation, and from these to derive and validate a Mortality Risk Index (MRI). A prospective cohort of elderly patients was set up in nine teaching hospitals. This cohort was randomly split up into a derivation cohort (DC) of 870 subjects and a validation cohort (VC) of 436 subjects. Data obtained from a Comprehensive Geriatric Assessment were used in a Cox model to predict 2-year mortality and to identify risk groups for mortality. A ROC analysis was performed to explore the validity of the MRI. Five factors were identified and weighted using hazard ratios to construct the MRI: age 85 or over (1 point), dependence for the ADL (1 point), delirium (2 points), malnutrition risk (2 points), and co-morbidity level (2 points for medium level, 3 points for high level). Three risk groups were identified according to the MRI. Mortality rates increased significantly across risk groups in both cohorts. In the DC, mortality rates were: 20.8% in the low-risk group, 49.6% in the medium-risk group, and 62.1% in the high-risk group. In the VC, mortality rates were respectively 21.7, 48.5, and 65.4%. The area under the ROC curve for overall score was statistically the same in the DC (0.72) as in the VC (0.71). The proposed MRI appears as a simple and easy-to-use tool developed from relevant geriatric variables. Its accuracy is good and the validation procedure gives a good stability of results.
Dramé
M
M
Faculty of Medicine, University of Reims Champagne-Ardenne, Reims, France.
Novella
J L
JL
Lang
P O
PO
Somme
D
D
Jovenin
N
N
Lanièce
I
I
Couturier
P
P
Heitz
D
D
Gauvain
J B
JB
Voisin
T
T
De Wazières
B
B
Gonthier
R
R
Ankri
J
J
Jeandel
C
C
Saint-Jean
O
O
Blanchard
F
F
Jolly
D
D
D000368:Aged; D000369:Aged, 80 and over; D015331:Cohort Studies; D004636:Emergency Service, Hospital; D005260:Female; D016330:Frail Elderly / Q000706:statistics & numerical data; D005602:France / Q000453:epidemiology; D015577:Geriatric Assessment / Q000379:methods*; D006784:Hospitals, Teaching; D006801:Humans; D007407:Interviews as Topic; D008297:Male; D009026:Mortality; D011379:Prognosis; D016016:Proportional Hazards Models; D012372:ROC Curve; D018570:Risk Assessment / Q000379:methods*; D012720:Severity of Illness Index